Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’

Aybala Agac Ay; Abdullah Çetin

doi:doi:10.11648/j.cmr.20130206.18

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Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’

Aybala Agac Ay, Abdullah Çetin

Published in Clinical Medicine Research (Volume 2, Issue 6)

Received: 20 November 2013 Published: 20 December 2013

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Abstract

Aim: Thyroid fine-needle aspiration biopsy (TFNAB) is the gold standard methodology for the evaluation of thyroid nodule. Nevertheless, diagnosis of TFNAB specimens is sometimes interpreted as “follicular lesion of undetermined significance”: This indeterminate diagnosis is given upon TFNAB despite the presence of sufficient cellular material available for cytopathological analysis. Furthermore, this indeterminate diagnosis constitutes a grey zone between benign lesion and malignancy. As a result, it becomes difficult to determine the type of surgical intervention that needs to be performed on the patient and the technique that will be used. In this study, we aim to correlate the diagnosis of “follicular lesion of undetermined significance” with clinical and postoperative evaluations. Methods: A total of 147 patients, who were diagnosed as “follicular lesion of undetermined significance” following initial TFNAB, were included in this retrospective study. These patients were evaluated according to whether they underwent a second TFNAB or thyroidectomy pathology following initial diagnosis of “follicular lesion of undetermined significance”. Results: Results were generated by evaluating the reports of the second TFNAB and 15 of 147 patients were followed. Histopathological examination of specimens derived from 132 patients following surgery revealed the following diagnosis: (i) hyperplasia in 67 patients, (ii) nodular lesion belonging to Hashimoto’s thyroiditis in 34 patients, (iii) papillary carcinoma in 28 patients, (iv) follicular carcinoma in two patients, and (v) anaplastic carcinoma in one patient. Conclusion: Based on this retrospective study and on examination of the available literature concerning the treatment options and follow-up of patients initially diagnosed as “follicular lesion of undetermined significance” (FLUS or Atypia of undetermined significance) upon TFNAB, we conclude that it is important to keep in mind the elevated rates of malignancy that potentially develop from these undetermined lesions. is electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.

Published in	Clinical Medicine Research (Volume 2, Issue 6)
DOI	10.11648/j.cmr.20130206.18
Page(s)	158-161
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2013. Published by Science Publishing Group

Keywords

Atypia of Undetermined Significance, FLUS, Follicular Lesion of Undetermined Significance, TFNAB, Thyroid Cancer

References

[1]	Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for Fine-needle aspiration of thyroid lesions according to the bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 2010;(134):450-6
[2]	Melillo RM, Santoro M, Vecchio G.Differantial diagnosis of thyroid nodules using fine-needle aspiration cytology and oncogene mutation screening: are we ready? F1000 Medicine Reports 2010;(2):62-6
[3]	Broome JT, Solorzano CC. The impact of atypia/follicular lesion of undetermined significance on the rate of malignancy in thyroid fine-needle aspiration:evaluation of the bethesda system for reporting thyroid cytopathology. Surgery 2011 Dec;150(6):1234-41
[4]	Krane JF, Vanderlaan PA, Faquin WC,Renshaw AA. The atypia of undetermined significance /follicular lesion of undetermined significance: malignant ratio:a proposed perfomance measure for reporting in the bethesda system for thyroid cytopathology.Cancer Cytopathol 2012 Apr 25;120(2):111-6
[5]	Bongiovanni M, Krane JF, Cibas ES, Faquin WC.The atypical thyroid fine-needle aspiration: past, present and future. Cancer Cytopathol 2012 Apr 25;120(2):73-86
[6]	Song JY, Chu YC, Kim L, Park IS, Han JY, Kim JM. Reclassifying formerly indeterminate thyroid FNAs using bethesda system reduces the number of inconclusive cases. Acta Cytol 2012;56(2):122-9
[7]	Ohori NP, Schoedel KE. Variablity in the atypia of undetermined significance diagnosis in the bethesda system for reporting thyroid cytopathology:sources and recommendations. Acta Cytol 2011;,55(6):492-8
[8]	Yassa L, Cibas ES, Benson CB. Long term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer 2007;(6):508-16
[9]	Nayar R, Ivanovic M. The indeterminate thyroid fine needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer 2009; (3):195-202
[10]	Teixeira GV, Chikota H, Teixeira T, Manfro G, Pai SI, Tufano RP. Incidence of malignancy in tyhroid nodules determined to be follicular lesions of undetermined significance on fine-needle aspiration. World J Surg 2012;36(1):69-74
[11]	Singh RS, Wang HH. Eliminating the ‘’Atypia of undetermined signifance/Follicular lesion of undetermined significance’’ category from the bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2011 Dec;136(6):896-902.
[12]	Na DG, Kim JH, Sung JY, Baek JH, Jung KC, Lee H.et al. Core-needle biopsy is more useful than repeat fine needle aspiration in thyroid nodules read as nondiagnostic of atypia of undetermined significance by the bethesda system for reporting thyroid cytopathology. Thyroid 2012;22(5):468-75
[13]	Chaves S, Fernandez-Acenero MJ, Cazorla A, Cedeno M, Fortes J, Gavin E. et al.Implementation of a joint protocol for the management of thyroid nodules with a cytological diagnosis of follicular lesion of undetermined significance: experience of one hospital. Cytopathology 2011 Oct 17. Doi: 10.1111/j.1365-2303.2011.00931.x.
[14]	Adeniran AJ, Hui P, Chhieng DC, Prasad ML, Schofield K, Theoharis C. BRAF mutation testing of thyroid fine needle aspiration specimens enhances the predictibility of malignancy in thyroid follicular lesions of undetermined significance. Acta Cytol 2011;55(6):570-5
[15]	Jing X, Knoepp SM, Roh MH, Hookim K, Placido J, Davenport R. et al.Group consensus revew minimizes the diagnosis of ‘’follicular lesion of undetermined significance’’ and improves cytohistologic concordance.Diagn Cytopathol 2011 May 2. doi: 10.1002/dc.21702.

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Aybala Agac Ay, Abdullah Çetin. (2013). Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’. Clinical Medicine Research, 2(6), 158-161. https://doi.org/10.11648/j.cmr.20130206.18

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ACS Style

Aybala Agac Ay; Abdullah Çetin. Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’. Clin. Med. Res. 2013, 2(6), 158-161. doi: 10.11648/j.cmr.20130206.18

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AMA Style

Aybala Agac Ay, Abdullah Çetin. Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’. Clin Med Res. 2013;2(6):158-161. doi: 10.11648/j.cmr.20130206.18

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@article{10.11648/j.cmr.20130206.18,
  author = {Aybala Agac Ay and Abdullah Çetin},
  title = {Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’},
  journal = {Clinical Medicine Research},
  volume = {2},
  number = {6},
  pages = {158-161},
  doi = {10.11648/j.cmr.20130206.18},
  url = {https://doi.org/10.11648/j.cmr.20130206.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20130206.18},
  abstract = {Aim: Thyroid fine-needle aspiration biopsy (TFNAB) is the gold standard methodology for the evaluation of thyroid nodule. Nevertheless, diagnosis of TFNAB specimens is sometimes interpreted as “follicular lesion of undetermined significance”: This indeterminate diagnosis is given upon TFNAB despite the presence of sufficient cellular material available for cytopathological analysis. Furthermore, this indeterminate diagnosis constitutes a grey zone between benign lesion and malignancy. As a result, it becomes difficult to determine the type of surgical intervention that needs to be performed on the patient and the technique that will be used. In this study, we aim to correlate the diagnosis of “follicular lesion of undetermined significance” with clinical and postoperative evaluations. Methods: A total of 147 patients, who were diagnosed as “follicular lesion of undetermined significance” following initial TFNAB, were included in this retrospective study. These patients were evaluated according to whether they underwent a second TFNAB or thyroidectomy pathology following initial diagnosis of “follicular lesion of undetermined significance”. Results: Results were generated by evaluating the reports of the second TFNAB and 15 of 147 patients were followed. Histopathological examination of specimens derived from 132 patients following surgery revealed the following diagnosis: (i) hyperplasia in 67 patients, (ii) nodular lesion belonging to Hashimoto’s thyroiditis in 34 patients, (iii) papillary carcinoma in 28 patients, (iv) follicular carcinoma in two patients, and (v) anaplastic carcinoma in one patient. Conclusion: Based on this retrospective study and on examination of the available literature concerning the treatment options and follow-up of patients initially diagnosed as “follicular lesion of undetermined significance” (FLUS or Atypia of undetermined significance) upon TFNAB, we conclude that it is important to keep in mind the elevated rates of malignancy that potentially develop from these undetermined lesions. is electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.},
 year = {2013}
}

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TY  - JOUR
T1  - Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’
AU  - Aybala Agac Ay
AU  - Abdullah Çetin
Y1  - 2013/12/20
PY  - 2013
N1  - https://doi.org/10.11648/j.cmr.20130206.18
DO  - 10.11648/j.cmr.20130206.18
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 158
EP  - 161
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20130206.18
AB  - Aim: Thyroid fine-needle aspiration biopsy (TFNAB) is the gold standard methodology for the evaluation of thyroid nodule. Nevertheless, diagnosis of TFNAB specimens is sometimes interpreted as “follicular lesion of undetermined significance”: This indeterminate diagnosis is given upon TFNAB despite the presence of sufficient cellular material available for cytopathological analysis. Furthermore, this indeterminate diagnosis constitutes a grey zone between benign lesion and malignancy. As a result, it becomes difficult to determine the type of surgical intervention that needs to be performed on the patient and the technique that will be used. In this study, we aim to correlate the diagnosis of “follicular lesion of undetermined significance” with clinical and postoperative evaluations. Methods: A total of 147 patients, who were diagnosed as “follicular lesion of undetermined significance” following initial TFNAB, were included in this retrospective study. These patients were evaluated according to whether they underwent a second TFNAB or thyroidectomy pathology following initial diagnosis of “follicular lesion of undetermined significance”. Results: Results were generated by evaluating the reports of the second TFNAB and 15 of 147 patients were followed. Histopathological examination of specimens derived from 132 patients following surgery revealed the following diagnosis: (i) hyperplasia in 67 patients, (ii) nodular lesion belonging to Hashimoto’s thyroiditis in 34 patients, (iii) papillary carcinoma in 28 patients, (iv) follicular carcinoma in two patients, and (v) anaplastic carcinoma in one patient. Conclusion: Based on this retrospective study and on examination of the available literature concerning the treatment options and follow-up of patients initially diagnosed as “follicular lesion of undetermined significance” (FLUS or Atypia of undetermined significance) upon TFNAB, we conclude that it is important to keep in mind the elevated rates of malignancy that potentially develop from these undetermined lesions. is electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.
VL  - 2
IS  - 6
ER  -

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Author Information

Aybala Agac Ay

K?r?kkale University, School of Medicine, General Surgery Department, K?r?kkale/Turkey
Abdullah Çetin

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Aybala Agac Ay, Abdullah Çetin. (2013). Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’. Clinical Medicine Research, 2(6), 158-161. https://doi.org/10.11648/j.cmr.20130206.18

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ACS Style

Aybala Agac Ay; Abdullah Çetin. Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’. Clin. Med. Res. 2013, 2(6), 158-161. doi: 10.11648/j.cmr.20130206.18

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AMA Style

Aybala Agac Ay, Abdullah Çetin. Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’. Clin Med Res. 2013;2(6):158-161. doi: 10.11648/j.cmr.20130206.18

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@article{10.11648/j.cmr.20130206.18,
  author = {Aybala Agac Ay and Abdullah Çetin},
  title = {Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’},
  journal = {Clinical Medicine Research},
  volume = {2},
  number = {6},
  pages = {158-161},
  doi = {10.11648/j.cmr.20130206.18},
  url = {https://doi.org/10.11648/j.cmr.20130206.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20130206.18},
  abstract = {Aim: Thyroid fine-needle aspiration biopsy (TFNAB) is the gold standard methodology for the evaluation of thyroid nodule. Nevertheless, diagnosis of TFNAB specimens is sometimes interpreted as “follicular lesion of undetermined significance”: This indeterminate diagnosis is given upon TFNAB despite the presence of sufficient cellular material available for cytopathological analysis. Furthermore, this indeterminate diagnosis constitutes a grey zone between benign lesion and malignancy. As a result, it becomes difficult to determine the type of surgical intervention that needs to be performed on the patient and the technique that will be used. In this study, we aim to correlate the diagnosis of “follicular lesion of undetermined significance” with clinical and postoperative evaluations. Methods: A total of 147 patients, who were diagnosed as “follicular lesion of undetermined significance” following initial TFNAB, were included in this retrospective study. These patients were evaluated according to whether they underwent a second TFNAB or thyroidectomy pathology following initial diagnosis of “follicular lesion of undetermined significance”. Results: Results were generated by evaluating the reports of the second TFNAB and 15 of 147 patients were followed. Histopathological examination of specimens derived from 132 patients following surgery revealed the following diagnosis: (i) hyperplasia in 67 patients, (ii) nodular lesion belonging to Hashimoto’s thyroiditis in 34 patients, (iii) papillary carcinoma in 28 patients, (iv) follicular carcinoma in two patients, and (v) anaplastic carcinoma in one patient. Conclusion: Based on this retrospective study and on examination of the available literature concerning the treatment options and follow-up of patients initially diagnosed as “follicular lesion of undetermined significance” (FLUS or Atypia of undetermined significance) upon TFNAB, we conclude that it is important to keep in mind the elevated rates of malignancy that potentially develop from these undetermined lesions. is electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.},
 year = {2013}
}

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TY  - JOUR
T1  - Should We Determine the Significance of “Follicular Lesion of Undetermined Significance’’
AU  - Aybala Agac Ay
AU  - Abdullah Çetin
Y1  - 2013/12/20
PY  - 2013
N1  - https://doi.org/10.11648/j.cmr.20130206.18
DO  - 10.11648/j.cmr.20130206.18
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 158
EP  - 161
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20130206.18
AB  - Aim: Thyroid fine-needle aspiration biopsy (TFNAB) is the gold standard methodology for the evaluation of thyroid nodule. Nevertheless, diagnosis of TFNAB specimens is sometimes interpreted as “follicular lesion of undetermined significance”: This indeterminate diagnosis is given upon TFNAB despite the presence of sufficient cellular material available for cytopathological analysis. Furthermore, this indeterminate diagnosis constitutes a grey zone between benign lesion and malignancy. As a result, it becomes difficult to determine the type of surgical intervention that needs to be performed on the patient and the technique that will be used. In this study, we aim to correlate the diagnosis of “follicular lesion of undetermined significance” with clinical and postoperative evaluations. Methods: A total of 147 patients, who were diagnosed as “follicular lesion of undetermined significance” following initial TFNAB, were included in this retrospective study. These patients were evaluated according to whether they underwent a second TFNAB or thyroidectomy pathology following initial diagnosis of “follicular lesion of undetermined significance”. Results: Results were generated by evaluating the reports of the second TFNAB and 15 of 147 patients were followed. Histopathological examination of specimens derived from 132 patients following surgery revealed the following diagnosis: (i) hyperplasia in 67 patients, (ii) nodular lesion belonging to Hashimoto’s thyroiditis in 34 patients, (iii) papillary carcinoma in 28 patients, (iv) follicular carcinoma in two patients, and (v) anaplastic carcinoma in one patient. Conclusion: Based on this retrospective study and on examination of the available literature concerning the treatment options and follow-up of patients initially diagnosed as “follicular lesion of undetermined significance” (FLUS or Atypia of undetermined significance) upon TFNAB, we conclude that it is important to keep in mind the elevated rates of malignancy that potentially develop from these undetermined lesions. is electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.
VL  - 2
IS  - 6
ER  -

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